Volume-9 | Issue-4 | April-2019 | PRINT ISSN No 2249-555X

Original Research Paper

Community Medicine

ASSESSMENT OF POISONING CASES IN A TERTIARY CARE HOSPITAL IN

KASHMIR VALLEY. A LONGITUDINAL STUDY

Wajeed Yousuf Senior resident in Department of Medicine GMC Srinagar

Kouser sideeq lone* Senior Resident Department Of Medicine GMC Srinagar *Corresponding Author
Adil Ashraf Resident Department of Obstetrics and Gynaecology GMC Srinagar
Najma Saqib Resident Department of Obstetrics and Gynaecology GMC Srinagar
Awadh Mueed Resident Department of Surgery GMC Srinagar
Yousuf
ABSTRACT Background: Poisoning is a major problem globally and its incidence is rising due to rapid industrialization and
urbanization. The exact incidence of acute poisoning is not known in India because of lack of any central poison registry.
Same is the case with Kashmir. The toxins involved in acute poisoning cases vary from place to place. In western countries, the commonest toxins
are medicinal agents. In contrast, in India, insecticides and pesticides are the most commonly consumed agents in adults while kerosene oil is the
most common toxin in children. Knowledge of commonly encountered poisons in a particular area is important for practicing physicians as it
may help in early diagnosis and institution of life-saving treatment.
Methodology: A longitudinal study was conducted in one of the two tertiary care hospitals in Kashmir valley. All the cases with poisoning
coming to the emergency department of the SMHS hospital for the period of one year were included in the study. Data were collected from the
history given by the patient, hospital records, police inquest reports and relatives.
Results: We studied 101 patients of poisoning in this longitudinal study .We found that 96 percent of cases were suicidal in nature and 4 percent
were accidental. In maximum cases reason was family issues and quarrel with family member's .Only four patients expired among this study
population due to poisoning. Major complication among these patients was hypernatrimia in 12.9%.
Conclusion: This study points towards the need of taking strict actions to restrict the easy availability and accessibility of poisonous chemicals
within the families and in the community to prevent the high cases of suicidal poisoning especially among students.

KEYWORDS :
INTRODUCTION were included in the study. After obtaining oral consent from the
Poisoning is now a day's becoming a significant global public health participants were feasible and the consent of parents or guardian in
problem .In 2012 as reported by World health organisation around others, the patients were studied from the time of admission in the
193,460 people died worldwide from unintentional poisoning with causality and then the status was followed up till recovery or death.
84% of these deaths occurring in low- and middle-income Data were collected from the history given by the patient, hospital
countries.(World Health Organization, 2018) Each year nearly a records, police inquest reports and relatives. Data was entered in
million people die as a result of suicide, and chemicals account for a Microsoft Office Excel and analysed in SPSS software. Data on age,
significant number of these deaths. It is estimated that deliberate sex, occupation, type of poison, route of exposure, associated co-
ingestion of pesticides causes 370,000 deaths each year.(Dawson et morbid conditions and outcome of poisoning were recorded and
al., 2010) These deaths can be reduced by limiting the availability of, analyzed by appropriate methods.
and access to, highly toxic pesticides. A poison is any substance that is
harmful to our body when ingested, inhaled, injected, or absorbed RESULTS:
through the skin.(Center For Disease Control, 2005) As per WHO Among the 101 patients majority were females with only 30.7% males.
statistics we see that developed countries have a high burden of deaths More than half (60%) of patients were students. Around 67% of the
due to poising and mostly suicidal followed by accidental poising. In patients belonged to nuclear families. Majority of the participants
India these cases are very often occurring with the use of agricultural belonged to the middle class according to Kuppuswami socio
pesticides and other chemicals. Over the last few decades agricultural economic classification. Majority of the participants were literate with
pesticides have become a common household item in rural areas of the 14.9% being graduate and 28.7% being educated up to higher
developing world.(Rajendran, 2003) Due to their easy availability, secondary. Poisoning was suicidal in 96%of cases and accidental in
pesticides have also become commonly used for intentional self- only 4% of cases. The mode of intake was oral in all the cases.10.9
poisoning. According to World Health Organization (WHO) estimates cases were stupurous on presentation. In 33.7% cases the reason was
published in 1990 (World Health Organization 1990), around 3 million quarrel with family and in 48 %the reason was unknown. Only 4 % of
poisoning cases with 220, 000 deaths occur annually.(Gunnell, the patients expired among the cases. About 32.6% cases landed up
Eddleston, Phillips, & Konradsen, 2007) About 99% of these deaths into complications with around 40 % of them having hypernatriemia as
occur in developing countries.(Gunnell et al., 2007) Pesticide complication. Among the cases there were 2 pregnant patients and 3
poisoning is a significant problem in India. Among the various patients with psychiatric disorders.
pesticide compounds Organophosphorus (OP) compounds cause most
self-poisoning deaths in southern and central India. In parts of northern Table 1: Socio demographic profile of the patients
India, aluminium phosphide caused most deaths in an epidemic that
started two decades ago. sex N Percentage
Females 70 69.3
In Kashmir there is a rise in the cases of poisoning but limited research Males 31 30.7
has been done in this area .we focused our study to understand the Total 101 100.0
pattern of poisoning cases in Kashmir and thus suggest preventive Occupation
measures.
Business 2 1.9
Methodology: Dependent 1 .99
A longitudinal study was conducted in one of the two tertiary care Farmer 6 5.9
hospitals in Kashmir valley. All the cases with poisoning coming to the Housewife 19 18.8
emergency department of the SMHS hospital for the period of one year student 61 60.4
INDIAN JOURNAL OF APPLIED RESEARCH 31
 Volume-9 | Issue-4 | April-2019 | PRINT ISSN No 2249-555X
Unemployed 12 11.8 REFERENCES:
1. Center For Disease Control. (2005). Morbidity and Mortality Weekly Report Case
Type of family Definitions for Chemical Poisoning depar tment of health and human ser (Vol. 54).
Joint 33 32.7 2. Center For Disease Control. (2015). Suicide Facts at a Glance 2015 Nonfatal Suicidal
Thoughts and Behavior. Retrieved from http://www.cdc.gov/ violenceprevention/ pdf/
Nuclear 68 67.3 suicide- datasheet-a.PDF
Socio economic classification 3. Dawson, A. H., Eddleston, M., Senarathna, L., Mohamed, F., Gawarammana, I., Bowe,
S. J., … Buckley, N. A. (2010). Acute human lethal toxicity of agricultural pesticides: A
Upper middle class 17 16.8 prospective cohort study. PLoS Medicine, 7(10). https://doi.org/10.1371/journal.pmed.
Lower middle class 73 72.3 1000357
4. Farzaneh, E., Mehrpour, O., Alfred, S., Moghaddam, H. H., Behnoush, B., &
Lower class 11 10.9 Seghatoleslam, T. (2010). Self-poisoning suicide attempts among students in Tehran,
Education N Percentage Iran. Psychiatria Danubina, 22(1), 34–38.
5. Gunnell, D., Eddleston, M., Phillips, M. R., & Konradsen, F. (2007). The global
Primary 19 18.8 distribution of fatal pesticide self-poisoning: Systematic review. BMC Public Health,
Middle to secondary 36 35.6 7(c), 1–15. https://doi.org/10.1186/1471-2458-7-357
6. Pires, M. C. da C., Silva, T. de P. S. da, Passos, M. P. dos, Sougey, E. B., & Bastos Filho,
Higher secondary 29 28.7 O. C. (2014). Risk factors of suicide attempts by poisoning: review. Trends in Psychiatry
Graduate 15 14.9 and Psychotherapy, 36(2), 63–74. https://doi.org/10.1590/2237-6089-2013-0044
7. Rajendran, S. (2003). Environment and Health Aspects of Pesticides Use in Indian
Table 2: characteristics of the poisoning cases Agriculture. In Third International Conference on Environment and Health (pp.
353–373). Retrieved from www.yorku.ca/bunchmj/ICEH/ proceedings/Rajendran_S_
Type of poising N Percentage ICEH_ papers_353to373.pdf
Suicide 97 96.0 8. Singh, B., & Kishore, K. (2017). Epidemiological profile of complete suicidal poisoning
cases autopsied at autopsy centre, RIMS, Ranchi. International Journal of Medical
Accidental 4 4.0 Toxicology and Forensic Medicine, 7(1), 32–42. Retrieved from http://journals. sbmu.
Total 101 100.0 ac.ir/ijmtfm/article/download/13190/pdf5%0Ahttp://ovidsp.ovid.com/ovidweb.cgi?T
=JS&PAGE=reference&D=emexa&NEWS=N&AN=615948787
Oral 101 100.0 9. World Health Organization. (2018). No Title. Retrieved March 3, 2018, from
Presentation http://www.who.int/ipcs/poisons/en/
Conscious 90 89.1
Stupurous 11 10.9
Reason in suicide
Family Issues 34 33.7
Personal 1 1.0
Quarrel With Family 12 12.9
Unknown 49 48.5
Outcome N Percentage
Expired 4 4.0
Survived 97 96.0
Hypernatremia 13 12.9
Metabolic acidosis 5 5
aspiration pneumonia 4 4
Others 5 5
Multiple complication 6 6
No complication 68 67.3
DISCUSSION:
Suicidal deaths are increasing each day and one of the modes of such
deaths is suicidal poisoning. As many poisonous chemical are easily
assessable now a day, it becomes important to ensure preventive
measures to stop such incidences. We did this study to explore the
various aspects behind the incidences of poisoning reported to the
hospital. Our findings points towards some of the important aspects of
poisoning cases which needs to be looked at. Poisoning was suicidal in
96%of cases and accidental in only 4% of cases. Majority of the cases
were females pointing towards the more vulnerability of females to
indulge in suicidal poising as a result of many social issues, these
results are comparable to the data from other parts of the country as
well as across various countries.(Gunnell et al., 2007) with More than
half (60%) of patients being students in our study shows the lack of
social support that students need to cope up with different situation of
life as these are the years when individuality is not sufficient to deal
with issues. Similar results have been shown in many other studies.
(Center For Disease Control, 2015) (Farzaneh et al., 2010) Majority of
the patients in our study belonged to the middle class according to
kuppuswami socio economic classification again pointing the need for
improving the coping mechanism for the working class.(Singh &
Kishore, 2017) Majority of the participants were literate with 14.9%
being graduate in our study and these results are similar to other
studies. (Pires, Silva, Passos, Sougey, & Bastos Filho, 2014) This
shows that education system needs to look after the preventive
strategies to educate and motivate the students form abstaining from
such actions especially starting in the beginning of adolescent years of
life. In 33.7% cases the reason was quarrel with family thus focus at the
family level can be very important in preventing such incidences.
Around 40 % of cases with complication had hypernatriemia as
complication because the treatment given causes this electrolyte
imbalance which needs to be looked after in such cases.

CONCLUSION:
The study concludes that among the poisoning cases that are reported
there is a very high prevalence of suicidal poisoning especially among
the students. This warrants towards taking strict actions to restrict the
easy availability and accessibility of such poisonous chemicals within
the families and in the community.
32 INDIAN JOURNAL OF APPLIED RESEARCH